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General NPI Number Information
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NPI Number | 1932862133
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Entity Type | Organization
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Legal Business Name | SPORT MEDICINE AND ORTHOPAEDIC CENTER INC
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Dates
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Enumeration Date | 10/15/2021
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Last Update Date | 10/15/2021
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Provider Practice Location Address
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Address Line | 5801 HARBOUR VIEW BLVD STE 201
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City | SUFFOLK
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State | VA
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Zip | 23435-2657
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Country | US
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Telephone | 757-842-7010
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Fax |
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Provider Business Mailing Address
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Address Line | 501 DISCOVERY DR
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City | CHESAPEAKE
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State | VA
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Zip | 23320-3843
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Country | US
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Telephone | 757-842-7010
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | RIANNON RUSCITTO
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Credential |
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Telephone | 757-842-7010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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